Patterns of Alcohol Use Among Patients Living With HIV in Urban, Large Rural, and Small Rural Areas

Abstract

Background For people living with HIV (PLWH), alcohol use is harmful and may be influenced by unique challenges faced by PLWH living in rural areas. We describe patterns of alcohol use across rurality among PLWH. Methods Veterans Aging Cohort Study electronic health record data were used to identify patients with HIV (ICD‐9 codes for HIV or AIDS) who completed AUDIT‐C alcohol screening between February 1, 2008, and September 30, 2014. Regression models estimated and compared 4 alcohol use outcomes (any use [AUDIT‐C > 0] and alcohol use disorder [AUD; ICD‐9 codes for abuse or dependence] diagnoses among all PLWH, and AUDIT‐C risk categories: lower‐ [1‐3 men/1‐2 women], moderate‐ [4‐5 men/3‐5 women], higher‐ 6‐7]), and severe‐risk [8‐12], and heavy episodic drinking (HED; ≥1 past‐year occasion) among PLWH reporting use) across rurality (urban, large rural, small rural) and census‐defined region. Findings Among 32,699 PLWH (29,540 urban, 1,301 large rural, and 1,828 small rural), both any alcohol use and AUD were highest in urban areas, although this varied across region. Predicted prevalence of any alcohol use was 54.1% (53.5%‐54.7%) in urban, 49.6% (46.9%‐52.3%) in large rural, and 50.6% (48.3%‐52.9%) in small rural areas (P < .01). Predicted prevalence of AUD was 14.4% (14.0%‐14.8%) in urban, 11.8% (10.0%‐13.5%) in large rural, and 12.3% (10.8%‐13.8%) in small rural areas (P < .01). Approximately 12% and 25% had higher‐ or severe‐risk drinking and HED, respectively, but neither differed across rurality. Conclusion Though some variation across rurality and region was observed, alcohol‐related interventions are needed for PLWH across all geographic locations.

Brain-behavior relations and effects of aging and common comorbidities in alcohol use disorder: A review.

“…For a scholarly review of AUD-HIV-HCV comorbidity with psychiatry, medication, and aging also considered, see Zahr (2018a). The U.S. Veterans Aging Cohort study found that the AUD prevalence rate of 32,699 people living with HIV ranged from 11.8% in rural areas to 14.4% in urban settings (Bensley et al, 2018). The comorbidities of AUD, HIV, and HCV take a toll on brain structure (Gullett et al, 2018; Pfefferbaum, Kwon et al, 2018) and function (Fama, Sullivan, Sassoon, Pfefferbaum, & Zahr, 2016; Gongvatana et al, 2014) possibly through a combination of inflammatory mechanisms stemming especially from HCV (Zahr, 2018b), interference of antiretroviral action from alcohol (Simon et al, 2018), or risk of nonadherence associated with drinking (Paolillo, Gongvatana, Umlauf, Letendre, & Moore, 2017) or drug use whether licit or illicit (Malbergier, Amaral, & Cardoso, 2015; but see Nolan et al, 2017).…”

Lifetime alcohol use among persons living with HIV is associated with frailty

“…Modifiable factors such as alcohol use are thought to accelerate aging in the general population 6 and may contribute to frailty among PLWH on cART. Alcohol use is prevalent in 50-66% of PLWH [7][8][9][10] . Nearly 27% of PLWH consume potentially hazardous quantities of alcohol 9,10 .…”

“…Nearly 27% of PLWH consume potentially hazardous quantities of alcohol 9,10 . An estimated 12-14% of PLWH may meet the criteria for an alcohol use disorder 8 . Interestingly, PLWH with a history of alcohol-related health complications are at an increased risk for hospitalization 11 .…”

Alcohol drinking and alcohol use disorder across the ages: Dynamic effects on the brain and function.

“…Among people living with HIV, the prevalence of AUD is nearly 15% in urban settings (Bensley et al, 2019). HIV+AUD comorbidity has the potential of compounding effects to cognitive deficits, noted in executive functioning, memory, and psychomotor and visuomotor speed (Cardenas et al, 2005;Durvasula et al, 2006;Fama, Rosenbloom et al, 2012;Fama et al, 2016;Saloner et al, 2020).…”